title: Differential induction of apoptosis by fludarabine monophosphate in leukemic B and normal T cells in chronic lymphocytic leukemia.
abstract: Fludarabine (F-ara-A), an adenine nucleoside analog with efficacy in B-cell chronic lymphocytic leukemia (B-CLL), has also been shown to have a long-lasting suppressive effect on T lymphocytes. In heterogeneous clinical samples, apoptosis cannot be detected by standard methods in small cellular subsets. We developed, therefore, a combined assay of in situ end-labeling of nicked DNA by terminal deoxynucleotide transferase, with measurements of cellular DNA content and surface antigens (CD3, CD4, CD8, and CD19) by multiparametric flow cytometry. This assay was used to determine F-ara-A-induced apoptosis in different lymphocyte subsets from CLL patients and normal controls treated with F-ara-A in vitro. Apoptosis was also correlated to bcl-2 protein levels. We observed a direct effect of F-ara-A on both B-CLL and T lymphocytes. The response to F-ara-A in B-CLL lymphocytes in vitro was Rai stage-dependent, the early-stages being more responsive (P = .01). Higher levels of spontaneous apoptosis were observed in B-CLL lymphocytes from early stage patients (P = .02). No difference was observed in spontaneous apoptosis of normal T cells in B-CLL, although T lymphocytes in late-stage disease were more sensitive to F-ara-A-induced apoptosis. Incubation with cyclosporin A did not affect B-CLL and T-lymphocyte survival compared with control cultures. Results suggested a direct apoptotic effect of F-ara-A on B-CLL lymphocytes that decreases with increasing clinical stage. No correlation was found between bcl-2 and spontaneous or F-ara-A-induced apoptosis. Apoptosis occurred at all cell-cycle stages and was not restricted to cells in S phase. The mechanisms of this stage-dependent apoptosis in CLL remain to be elucidated.
authors.affiliation: Section of Molecular Hematology and Therapy, Department of Hematology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: U
authors.initials: U
authors.lastname: Consoli
authors.forename: I
authors.initials: I
authors.lastname: El-Tounsi
authors.forename: A
authors.initials: A
authors.lastname: Sandoval
authors.forename: V
authors.initials: V
authors.lastname: Snell
authors.forename: H D
authors.initials: HD
authors.lastname: Kleine
authors.forename: W
authors.initials: W
authors.lastname: Brown
authors.forename: J R
authors.initials: JR
authors.lastname: Robinson
authors.forename: F
authors.initials: F
authors.lastname: DiRaimondo
authors.forename: W
authors.initials: W
authors.lastname: Plunkett
authors.forename: M
authors.initials: M
authors.lastname: Andreeff
mesh_terms: D018941:Antigens, CD19 / Q000032:analysis; D000964:Antimetabolites, Antineoplastic / Q000494:pharmacology*; D017209:Apoptosis; D001402:B-Lymphocytes / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D017252:CD3 Complex / Q000032:analysis; D015704:CD4 Antigens / Q000032:analysis; D016827:CD8 Antigens / Q000032:analysis; D002453:Cell Cycle; D016572:Cyclosporine / Q000494:pharmacology; D005434:Flow Cytometry; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000473:pathology*; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000378:metabolism; D013601:T-Lymphocytes / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D014407:Tumor Cells, Cultured; D001084:Vidarabine Phosphate / Q000031:analogs & derivatives* / Q000494:pharmacology
chemical_list: D018941:Antigens, CD19; D000964:Antimetabolites, Antineoplastic; D017252:CD3 Complex; D015704:CD4 Antigens; D016827:CD8 Antigens; D007166:Immunosuppressive Agents; D019253:Proto-Oncogene Proteins c-bcl-2; D001084:Vidarabine Phosphate; C042382:fludarabine phosphate; D016572:Cyclosporine